Early Symptoms of Rheumatoid Arthritis () courtecy;-
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What is rheumatoid arthritis (RA)? Discover rheumatoid
arthritis symptoms, diagnosis, and treatment.
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What Is Rheumatoid
Arthritis?
Rheumatoid arthritis
(RA) is an autoimmune disease where the body attacks the lining tissue of
joints, causing chronic joint inflammation. While it primarily affects joints,
it can also cause inflammation of organs, such as the lungs, eyes, skin, and
heart.
People with RA may
experience an increase in symptoms –called flares – that can last for days or
weeks. They may also have periods of remission where they have few or no
symptoms. There is no cure for rheumatoid arthritis, but medications can stop
the progression of the disease and ease symptoms.
Rheumatoid Arthritis Risk Factors
According to
the Arthritis Foundation, rheumatoid arthritis affects about 1.5 million people
in the U.S. Women develop RA two to three times more often than men, and
symptoms in women tend to appear between the ages of 30 and 60, while symptoms
often develop later in life for men. There may also be a genetic basis for the
disease. Cigarette smoking and periodontitis, are also risk factors.
Juvenile Rheumatoid Arthritis
Juvenile
rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA), is
a type of arthritis that occurs in children ages 1 to 16.
Juvenile Rheumatoid Arthritis Symptoms
·
Stiff, swollen, painful joints
·
Fever
·
Rash
Juvenile Rheumatoid Arthritis Diagnosis
To ultimately
be diagnosed with JRA the child's symptoms must last at least six weeks.
Juvenile Rheumatoid Arthritis Treatment
Several methods
of treatment are available for juvenile rheumatoid arthritis. Most children
need both medicinal and nonmedicinal treatments to relieve pain, reduce
swelling, maintain full movement in their joints, and treat complications.
·
Medication -- Over-the-counter pain medicines like aspirin,
ibuprofen, and naproxen are often the first line of defense against the pain of
juvenile rheumatoid arthritis. If those pain relievers do not work, a class of
drugs that slows the progression of juvenile RA may be used called disease
modifying antirheumatic drugs (DMARDs). The most commonly prescribed DMARD for
juvenile RA is methotrexate. Other drugs may be used for serious disease,
including corticosteroids and biologic agents. These medications have side
effects that should be discussed with your doctor.
·
Physical Therapy -- Regular exercise designed by a physical
therapist can help to retain a child’s range of motion in their joints, as well
as muscle tone.
Healthy Joints vs. Arthritic Joints
Arthritis
refers to more than 100 conditions that affect the musculoskeletal system. The
joints are the parts of the body where bones meet each other. When arthritis is
present, the joints may become inflamed, stiff, red, and painful. Damage from
RA may occur in tissues surrounding the joints including the tendons,
ligaments, and muscles. RA is one type of arthritis classified as 'systemic,'
meaning it can areas throughout the body. In some patients, symptoms may extend
to the skin and eyes, and internal organs, including the liver, kidneys, heart,
and lungs.
What Causes Rheumatoid Arthritis?
The exact cause
of RA remains unknown, but several risk factors have been identified. Women are
diagnosed with RA more often, and it is suspected estrogen may play a role.
Several studies have shown there is a genetic component to developing RA.
Cigarette smoking appears to increase the risk of developing the disease.
Occupational exposure to certain dusts such as silica, wood, or asbestos can
also lead to a higher risk for developing the illness. It is thought there may
be a viral or bacterial infectious cause of RA but that is still being studied.
Rheumatoid Arthritis Symptoms: Flares
When a person
with RA has symptoms including joint inflammation and pain, this is called a
flare. Flares may last from weeks to months. This can alternate with periods of
remission, when symptoms are minimal to nonexistent. Periods of remission can
last weeks, months, or even years. After a period of remission, if the symptoms
return this is called a relapse. It is common for RA patients to have periods
of flares, remissions, and relapses, and the course of the illness varies with
each patient.
Rheumatoid Arthritis Symptoms
In addition to
the hallmark symptoms of swollen, painful, and stiff joints and muscles,
patients with RA may also experience other symptoms.
Other Symptoms of Rheumatoid Arthritis
·
Fatigue
·
Low-grade fever
·
Lack of energy
·
Loss of appetite
·
Bumps under the skin (rheumatoid nodules)
·
Shortness of breath due to inflammation or damage to the lungs
·
Hoarseness
·
Eye problems
In addition to
these symptoms, muscle and joint stiffness of rheumatoid arthritis is usually
worst in the morning or after extended periods of inactivity.
Rheumatoid Arthritis Symptoms: Joint Pain
With RA, hands
are almost always affected. However, RA can affect any joint in the body,
including wrists, elbows, knees, feet, hips, and even the jaw. Usually, joints
are affected symmetrically, meaning the same joints on both sides of the body
are affected. Rheumatoid arthritis can be very painful, and chronic
inflammation can lead to debilitating loss of cartilage, bone weakness, and
joint deformity.
Rheumatoid Arthritis
Symptoms: Inflammation of Organs
Rheumatoid arthritis is
a systemic disease, meaning it can affect the entire body. In addition to the
joints and muscles, RA can cause problems in many other areas of the body:
·
Eyes and mouth:
inflammation of the glands in the eyes and mouth causes dryness, and an
autoimmune disease of the tear and saliva glands called Sjögren's syndrome. It
can also lead to inflammation of the white part of the eye (scleritis).
·
Lungs: inflammation of
the lung lining (pleuritis) or the lungs themselves can cause shortness of
breath and chest pain.
·
Heart: inflammation of
the tissue surrounding the heart (pericarditis) can cause chest pain, which
tends to be worse when lying down. RA patients are also at greater risk for
heart attacks.
·
Spleen: inflammation of
the spleen (Felty's syndrome) can cause a decrease in white blood cells, which
raises the risk of infections.
·
Skin: firm lumps under
the skin (rheumatoid nodules), typically located around affected joints, often
on pressure points such as elbows, fingers, and knuckles.
·
Blood vessels:
inflammation of the blood vessels (vasculitis) can limit blood supply to
surrounding tissues, causing tissue death (necrosis).
What is a Rheumatologist?
A
rheumatologist is usually an internal medicine specialist or pediatrician, with
specialized rheumatology training to identify and treat the more than 100
different types of arthritis in addition to other autoimmune disorders such as
lupus, polymyositis, and vasculitis.
Rheumatoid Arthritis in Hands
There is no
singular test to diagnose rheumatoid arthritis. First, the doctor will perform
a physical and take a history of symptoms. The joints will be examined to
determine if there is inflammation and tenderness. The heart, lungs, eyes,
mouth, and extremities will be evaluated. And the skin may be examined to look
for rheumatoid nodules. The doctor may order blood tests or X-rays to help
diagnose the condition.
Many other
diseases such as gout, fibromyalgia, and lupus may resemble rheumatoid
arthritis, so the doctor will rule out these conditions before making a
diagnosis of RA.
Rheumatoid Arthritis Diagnosis: Citrulline
Antibody Test
Blood tests are
usually run to help make a diagnosis of rheumatoid arthritis. These tests check
for certain antibodies including anti-cyclic citrullinated peptide antibodies
(ACPA), rheumatoid factor (RF), and antinuclear antibodies (ANA), which are
present in a majority of RA patients.
Rheumatoid
factor (RF) is present in about 75% to 80% of RA patients, and a high RF may
indicate a more aggressive form of the disease. Antinuclear antibodies (ANA) is
not specific for a diagnosis for RA, but their presence can indicate to the
doctor that an autoimmune disorder may be present.
Rheumatoid Arthritis Diagnosis: Sedimentation
Rate (Sed Rate)
Other blood
tests that may be run can help the doctor determine the extent of the
inflammation in the joints and elsewhere in the body. The erythrocyte
sedimentation rate (ESR, or "sed rate") measures how quickly red
blood cells fall to the bottom of a test tube. Typically, the higher the sed
rate, the more inflammation there is in the body.
Another blood
test that measures inflammation is the C-reactive protein (CRP) test. If the
CRP is high, inflammation levels are usually high as well, such as during a
flare of rheumatoid arthritis.
Rheumatoid Arthritis Diagnosis: Imaging Tests
Another test
used to diagnose rheumatoid arthritis is X-ray. Early in the disease X-rays can
be helpful as a baseline test and they can be useful in later stages to monitor
how the disease progresses over time. Other imaging tests used include
ultrasound and magnetic resonance imaging (MRI).
Rheumatoid Arthritis Diagnosis: Arthrocentesis
A joint
aspiration procedure (arthrocentesis) may be performed to obtain joint fluid to
test in the laboratory. A sterile needle and syringe are used to drain fluid
from the joint, which is then analyzed to detect causes of joint swelling.
Removing this joint fluid can also help relieve joint pain. Sometimes,
cortisone may be injected into the joint during the aspiration procedure for
more immediate relief of inflammation and pain.
Osteoarthritis vs. Rheumatoid Arthritis
Currently,
there is no cure for rheumatoid arthritis, but there are a number of
medications that can ease its symptoms. Most treatments are aimed at remission,
where the patient has few or no symptoms of RA. When treatment is started early
on in the disease process, this can help minimize or slow damage to the joints
and improve quality of life for patients. Treatment usually involves a
combination of medication, exercise, rest, and protecting the joints.
Sometimes, surgery may be needed.
Rheumatoid Arthritis Treatment: Medications
If you are
diagnosed with rheumatoid arthritis, the sooner the treatment begins, the
better your outcome is likely to be. There are many different medications used
to help alleviate symptoms of RA and with the goal of bringing a patient into
remission.
Common Drugs for Rheumatoid Arthritis
·
Disease-modifying antirheumatic drugs (DMARDs) such as
methotrexate, hydroxycholorquine (Plaquenil), sulfasalazine (Azulfidine,
Azulfidine EN-Tabs), leflunomide (Arava), and azathioprine (Imuran)
·
Biologic response modifiers (another type of DMARD) such as
abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab and
pegol (Cimzia) etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi),
and rituximab (Rituxan)
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Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen
(Advil, Motrin), ketoprofen (Actron, Orudis KT), naproxen sodium (Aleve), and
celecoxib (Celebrex)
·
Janus kinase (JAK) Inhibitor – a new drug called tofacitinib
(Xeljanz)
·
Corticosteroids
·
Analgesics (painkillers)
Drugs used to
reduce pain (analgesics) and inflammation (NSAIDs) are often considered
"first-line" drugs as they are fast-acting and can relieve symptoms
quickly. Medications such as DMARDs and biologic drugs take longer to have an
effect, but they can help prevent inflammation and joint damage.
Rheumatoid Arthritis
Treatment: Alternative Medicine
While there is no
special diet people with rheumatoid arthritis should follow, eating a healthy,
balanced diet is always recommended, and some foods may help ease inflammation.
·
Omega-3 fatty acids
found in fish oil may offer anti-inflammatory benefits, so fish such as
herring, mackerel, trout, salmon, and tuna may be a part of a healthy diet. If
you choose to take fish oil supplements, check with your doctor for the proper
dosage.
·
Extra fiber from fruits,
vegetables, and whole grains can result in a lower C-reactive protein (CRP) in
the blood. High levels of CRP indicate inflammation.
·
Vitamin D may help lower
the risk for RA in women. Eggs, fortified breads and cereals, and low-fat milk
contain Vitamin D.
Rheumatoid Arthritis
Treatment for Other Parts of the Body
Rheumatoid arthritis can
also affect other areas of the body, and these symptoms may be treated
individually.
·
Sjögren's syndrome can
cause eye dryness and may be treated with eye drops to moisturize, and also
drops to increase tear production such as cyclosporine (Restasis). Dry mouth
related to Sjögren's may be treated with certain mouthwashes and toothpastes.
·
Inflammation of the lung
lining (pleuritis) or the lungs themselves may require treatment with
corticosteroids.
·
Inflammation of the
tissue surrounding the heart (pericarditis) usually requires keeping the
overall inflammation levels down and many RA drugs can help.
·
Inflammation of the
spleen (Felty's syndrome) can cause a decrease in white blood cells, which
raises the risk of infections and may be treated with a stimulating factor
(granulocyte stimulating factor/GSF) used to increase the amount of white blood
cells.
·
Rheumatoid nodules may
require injections of steroids, or surgery to remove them if they are severe.
·
Inflammation of the
blood vessels (vasculitis) may be treated with painkillers, antibiotics, and
protecting the areas affected.
Rheumatoid Arthritis Treatment: Physical
Activity and Rest
A balance of
physical activity and rest periods are important in managing rheumatoid
arthritis. Exercise more when your symptoms are minimal, rest more when your
symptoms are worse.
Exercise and Rheumatoid Arthritis
Exercise helps
maintain joint flexibility and motion. There are therapeutic exercises with
physical therapy that is prescribed, that can help with strength, flexibility,
and range of motion of specific joints or body parts affected by your RA. Many
recreational activities such as walking swimming are helpful because allow
movement with little to no impact on the joints. Consult your rheumatologist or
physical therapist to find out what exercises are right for you.
Types of Exercises for Rheumatoid Arthritis
Physicians
often recommend the following sports and exercises for their relatively
low-stress impact on joints.
·
Walking
·
Bicycling
·
Swimming
·
Movement (yoga, tai chi, etc.)
·
Strength building
Just as
physical activity is important, so is rest. When you have an RA flare and your
symptoms are worse, it is best to reduce your activity to help minimize joint
inflammation and pain, and to cope with fatigue.
Surgery for Rheumatoid Arthritis
With severe rheumatoid arthritis, surgery may be needed to reduce
pain and improve joint function. Some surgeries include joint replacement,
fusion of joints (arthrodesis), tendon reconstruction, and removal of inflamed
tissues (synovectomy). Discuss your treatment options with your doctor to find
out what is right for you.
Additional Information on Rheumatoid Arthritis (RA)
For more information about Rheumatoid Arthritis (RA), please
consider the following:
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Reviewed by William C. Shiel Jr., MD,
FACP, FACR on Wednesday,
August 17, 2016
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Rheumatoid
Arthritis (RA) Symptoms & Treatment
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Sources: 
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This tool does not
provide medical advice
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This tool does not provide medical advice
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